Relationship between frailty and loneliness among community-dwelling Turkish older people

Uncovering the impact of loneliness in ageing populations: a comprehensive scoping review

BACKGROUND

Europe's aging population increasingly faces social isolation and loneliness, with nearly 20% of older adults living alone. Social isolation refers to an objective lack of social contact, while loneliness is the subjective experience of unmet social needs. Both are prevalent among community-dwelling older adults, driven by life transitions, loss, and declining health. These issues severely impact mental and physical health, increasing risks of depression and suicidal ideation. This scoping review maps the literature, identifies knowledge gaps, and highlights key challenges regarding loneliness and social isolation in this population.

METHODS

A scoping review was conducted between March and September 2024, following the PRISMA guidelines for scoping reviews. The review adhered to Arksey and O'Malley's five-stage framework, which includes identifying research questions, searching for and selecting relevant studies, extracting data, and synthesizing results. The search was conducted in major scientific databases, including Embase, CINAHL Plus, Web of Science, and PsycINFO, along with grey literature sources, including doctoral theses and organizational reports.

RESULTS

A total of 45 studies were included, with 66.6% using quantitative methods, 11.1% using qualitative methods, and the remainder being systematic reviews or mixed-method analyses. The studies revealed a significant prevalence of loneliness and social isolation among community-dwelling older adults, with risk factors including health deterioration, widowhood, and loss of social networks. The consequences of loneliness and isolation span physical and mental health issues, including an increased risk of cardiovascular disease, anxiety, depression, and cognitive decline.

CONCLUSIONS

Loneliness and social isolation among community-dwelling older adults are complex issues with profound implications for physical, mental, and social well-being. Addressing these challenges requires integrative approaches that consider individual, relational, and contextual factors. Further longitudinal and standardized research is needed to improve our understanding of the long-term impacts and effectiveness of interventions to mitigate these issues.

Longitudinal relationship between loneliness and cognitive function among unmarried older adults in Malaysia: exploring gender disparities

BACKGROUND

The status of being unmarried is commonly associated with a higher tendency for loneliness and cognitive impairment. However, it has yet to be determined whether there is a link between loneliness and cognitive function among unmarried older people. Therefore, this study used longitudinal data to determine the link between loneliness and cognitive function, and the subjects were unmarried community-dwelling older adults.

METHODS

The study follows up a sample of 733 unmarried older adults who were either never married, widowed, divorced or separated, from waves one and two of the 'Neuroprotective Model for Healthy Longevity among Malaysian Older Adults' study. The main statistical analysis used to answer the research question was the PROCESS macro (model 1) for SPSS.

RESULTS

The study found that increased loneliness was associated with a decline in cognitive function over a 3-year period. Additionally, gender moderated the link between loneliness and cognitive function, with this association being particularly prominent in older men.

CONCLUSIONS

Loneliness among unmarried older people should be given attention as it could lead to deteriorating cognitive function. Notably, older men experience a more substantial impact of loneliness on cognitive function than women. Therefore, special attention should be focused on this population, and more social services should be developed to reduce the incidence of cognitive impairment, improve their quality of life, and promote successful ageing.

Prevalence and predisposing factors of frailty and social inclusion among older adults: A cross-sectional study

OBJECTIVE

The present study aimed to identify the prevalence and predisposing factors of frailty and social inclusion among community-dwelling older adults.

DESIGN

The study was conducted using a cross-sectional design.

SAMPLE

The target population consisted of older adults registered in five family health centers in a city in Turkey. The study was completed with 600 older adults.

MEASUREMENTS

The Tilburg frailty indicator (TFI) and the social inclusion scale were used to collect data.

RESULTS

The prevalence of frailty in older adults was 60.5%. Multiple logistic regression analysis indicated that the risk of frailty was found to be higher in older adults aged 75 and over (2.5 times), those with low education level (5.8 times), those who were single (2 times), those with chronic diseases (1.8 times), those with unhealthy lifestyle (2.8 times), and those who were dissatisfied with their home living environment (5.9 times). It was found that age, education level, marital status, income, presence of chronic disease, lifestyle, satisfaction with their home living environment, and frailty explained 50% of the variance in social inclusion.

CONCLUSION

The study concluded that most community-dwelling older adults were frail, and social inclusion was lower in those frail. Age, education level, marital status, lifestyle, presence of chronic disease, and satisfaction with their home living environment were found to be predisposing factors for both frailty and social inclusion. Public health nurses could develop strategies to prevent frailty in older adults and increase activities that encourage participation in social life.

Causal effects of socioeconomic traits on frailty: a Mendelian randomization study

Background

The relationship between socioeconomic status and frailty has been extensively investigated in the literature, but it remains unclear whether a causal relationship exists. Our goal is to evaluate the causal relationship between six socioeconomic traits and the frailty index using summary-level data for single nucleotide polymorphisms from large genome-wide association studies with individuals of European ancestry.

Methods

A two-sample MR was performed. We applied the inverse variance weighted (IVW) method for the primary estimate, with sensitivity analyses conducted using alternative MR methods to evaluate the robustness of the findings. A subsequent multivariable MR was undertaken to adjust for the effects of body mass index (BMI). Finally, the MR Steiger directionality test was performed to confirm the causal direction.

Results

The IVW MR analysis revealed significant associations between various socioeconomic factors and the frailty index. Specifically, genetically predicated age completed full time education (β = -0.477, 95% confidence interval [CI]: -0.634 to -0.319) and average total household income before tax (β = -0.321, 95% CI: -0.410 to -0.232) were negatively associated with the frailty index. On the other hand, genetically predicted job involves heavy manual or physical work (β = 0.298, 95% CI: 0.113 to 0.484), job involves mainly walking or standing (β = 0.179, 95% CI: 0.013 to 0.345), Townsend deprivation index at recruitment (β = 0.535, 95% CI: 0.285 to 0.785), and social isolation/loneliness (β = 1.344, 95% CI: 0.834 to 1.853) were positively associated with the frailty index. Sensitivity analysis using other MR methods and multivariable MR analysis adjusting for BMI yielded stable results. The MR Steiger directionality test confirmed the causal direction.

Conclusion

Our findings highlight the importance of socioeconomic factors in affecting frailty risk. Future research should focus on unraveling the pathways through which these socioeconomic factors exert their effects on frailty, with the ultimate goal of developing targeted strategies to mitigate the risk of frailty.

Implementation of a Comprehensive and Personalised Approach for Older People with Psychosocial Frailty in Valencia (Spain): Study Protocol for a Pre-Post Controlled Trial

With ageing, the risk of frailty increases, becoming a common condition that exposes older people to an increased risk of multiple adverse health outcomes. In Valencia (Spain), the ValueCare project develops and applies a value-based care approach that addresses the multidimensional nature of frailty by implementing integrated and personalized care to tackle psychosocial frailty. A pre-post controlled design with a baseline measurement at inclusion, at the end of implementation and a follow-up measurement after 6 months of intervention. In Valencia (Spain), 120 participants over 65 years of age are recruited from primary care centres to receive the ValueCare comprehensive and personalised care plan according to the results and are compared with 120 participants receiving "usual care". An assessment questionnaire is designed using validated instruments, and a personalised care plan is developed specifically for each participant based on the results obtained. The study protocol has been registered under the ISRCTN registration number ISRCTN25089186. Addressing frailty as a multidimensional and multifactorial risk condition requires the development and implementation of comprehensive assessments and care. In this context, this study will provide new insights into the feasibility and effectiveness of a value-based methodology for integrated care supported by ICT for older people experiencing frailty.

The relationship between frailty and social vulnerability: a systematic review

Both frailty (reduced physiological reserve) and social vulnerability (scarcity of adequate social connections, support, or interaction) become more common as people age and are associated with adverse consequences. Analyses of the relationships between these constructs can be limited by the wide range of measures used to assess them. In this systematic review, we synthesised 130 observational studies assessing the association between frailty and social vulnerability, the bidirectional longitudinal relationships between constructs, and their joint associations with adverse health outcomes. Frailty, across assessment type, was associated with increased loneliness and social isolation, perceived inadequacy of social support, and reduced social participation. Each of these social vulnerability components was also associated with more rapid progression of frailty and lower odds of improvement compared with the absence of that social vulnerability component (eg, more rapid frailty progression in people with social isolation vs those who were not socially isolated). Combinations of frailty and social vulnerability were associated with increased mortality, decline in physical function, and cognitive impairment. Clinical and public health measures targeting frailty or social vulnerability should, therefore, account for both frailty and social vulnerability.

Association between Sense of Loneliness and Quality of Life in Older Adults with Multimorbidity

BACKGROUND

Multimorbidity has been associated with adverse health outcomes, such as reduced physical function, poor quality-of-life (QoL), poor self-rated health.

OBJECTIVE

The association between quality of life, social support, sense of loneliness and sex and age in older adult patients affected by two or more chronic diseases (multimorbidity) was evaluated.

METHODS

Patients n. 162 with multimorbidity and living with family members.

TESTS

MMSE-Mini-Mental-State-Examination; ADL-Activities of Daily Living; Social Schedule: demographic variables; Loneliness Scale -de Jong Gierveld; Quality-of-Life-FACT-G; WHOQOL-BRIEF Social relationships.

STATISTICAL ANALYSIS

Multivariate Regression Analysis.

RESULTS

The patients with three or more diseases have worse dimensions of FACT-G total score (p = 0.029), QoL Physical-well-being (p = 0.003), Social well-being (p = 0.003), Emotional-well-being (p = 0.012), Functional-well-being (p < 0.001), than those with two. Multiple linear regression QoL: FACT_G total score, PWB, SWB, EWB, FWB as dependent variables. In the presence of multimorbidity with an increase in the patient's age FACT-G total score (B = -0.004, p = 0.482), PWB (B = -0.024, p = 0.014), SWB (B = -0.022, p = 0.051), EWB (B = -0.001, p = 0.939), FWB (B = -0.023, p = 0.013) decrease by an average of 0.1, and as the sense of solitude increases FACT-G total score (B = -0.285, p < 0.000), PWB (B = -0.435, p < 0.000), SWB(B = -0.401, p < 0.000), EWB(B = -0.494, p < 0.000), FWB(B = -0.429, p < 0.000) decrease by 0.4.

CONCLUSIONS

A sense of loneliness and advancing age are associated with bad quality-of life in self-sufficient elderly patients with multimorbidity.

IMPLICATIONS FOR PRACTICE

Demonstrating that loneliness, as well as in the presence of interpersonal relations, is predictive of worse quality of life in patients with multimorbidity helps identify people most at risk for common symptoms and lays the groundwork for research concerning both diagnosis and treatment.